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03070171 (2) CITY OF CUPERTINO '° "'+ '� •moi a. wa4 "� "' �`"` " " BUILDING nlvlsloN PERMIT. CONTRACTnR INFORMATI , BUILDING ADDRESS: PERMIT NO03070171 3070171 1672 2TRIERNS GREEK PT�VD OW NER'S NAME: PERMIT ISSUE DATE E: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Lodi LICENSED CONTRACnderp DECLARATION' tu I hereby)form than 1 am r he B.under radPr.fC ,, Chapter 9(commencing lob Description ^ t.{ inf 11 f lion]Q]IB of Division3of the Bu and PmlcssinmC a cense is EEE in full farce a d if zq_ Llee.xeClaes _Lm.« �l2' 7 f/I R & R 3 EXISTING A/C a COOP ARCHITECTS UARATION CONTRACTOR: AMERICA HOMES HEAT & COOL SERVICES Dai 1 un col^I�Y plan M 4YAS RuALucc r5{s /fes O�U ii 70 y�lrL�/` o C Licensed Pmfcssirinel OWNER-BUILDER DECLARATION g7 1 hereby affirm that I em exempt from the Contractor's License Law for the ZOO following mason.(Section 7031.5,Business and Professions Code:Any city nr munry which acquires a permit m cmtswm,alien improve,demolish,or repair any structure HZaprior 1.its issuance.also mquirershe applicant(.,such pen iuo flu signed nemmcm that he is licensed pursuant In the provist.ns of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valu t, ass€ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 4 e;$R that he is exempt thcafrom and the basis for the alleged exemption.Any vinlafion of Section 7031.5 by any Applicant(.r a permit anbjeCU the Applicant to A Civil Penalty of rA�HAi�ih.M�AerQ 0 Occupancy Type not more Nan five hundred3 dollen(SS(p). —rhL ++11`` tl ❑1,as owner of the Ordinary,or my employees with wages as their sole compensation, will do Ne work and the structure is not intended or miffed toraak(Sec.7044,Business Re(qjaired Inspections and Professionswh ldsoe:The Contractor's Liam.taw doss not apply if an owner of 303 — ROUGH MECHANICAL property oolim ours Merton,and who doss each wank himself.(n his of own employees,provided that such improvemerm am not intended or offered for sale.If. 304 — ROUGH ELECTRICAL however,the building of improvement is sold within one year.(completion,the owner- �''y J gLoO9 nm builder.). will have the burden of proving Nu lie slid not build or improve for purpose of 505 - FINAL ELECTRICAL AUG 2 /508 - FINAL MECHANICAL p� co I.as owner of the Sec,property .B sines andely contusions with licensed )rodeos to ��'�D�Stl� cease L the project(Sec.7044,Business end Professions ds or I The Character's thecmrk Li- come Law coca not apply to ts owner of PruPery who Wilds or Improves Ibeacrac and who contracts for such projects with a conuactor(q licensed pursuant to the Contractor's _ License LAW. ❑I em exempt under See. .B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION 1 booby affirm under Penalty of perjury aro of the following declarations: ave and will maintain a CertlGeme of Consent to self-insure for Worker's Compen- as provided for by Section 3700 of the Labor Code,for the performance Of the work for which this permit is issued. ❑I have and will maintain Worked Compensation Insunnec,as minimal by Section 37W of the Labor Co,Sep,for the theRje Performance of the work for which this Permit is Issued. e Coni My We CERTIFICATE TIK ATE OF CPJCEFIIPIIOI Zito Ly COMPENSATION INSURANCE (This section need not W compacted if the Permit is for one hundred dollars(SIM) nr len.) I certify that in be performance of the work for which this Permit is issued,1 shall not employ any person in any manner an u in become subject to the Workeri Compensation Laws of Celi(ornis.Date Applicant NOTICE TO APPLICANT:If,after making his Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the LaMx Cade.you mon ' .J O forthwith comply with such provisions or this permit shall be deemed invoked. z CONSTRUCTION LENDING AGENCY -(-+4 I hereby affirm that there is a Conswction lending agency lar she Performance of ' C> the Work which,has permit is issued(Sec.3097,Civ.C.I {[7 A Lender's Name Lender's Ad Adtlrcss U Q I certify Net 1 have read this application and auto than the above information is it. Coach.lagree to comply with all city And county oNinances and sane laws relating to p V building connmction,and hereby authorize reprnentaninS of this city to enter upon the W above-mentioned property for inspection purposes. gy (We))gree la save,indemnify and keep harmless the City of Cupenim,against (q Iiabilitirs,judgmcnts,costa antl mpcnus which may in any way eccmc against Said City UZ in consequence of the granting of this Permit. PLICAPLICA—�S NDS A�COIAPLY WITH ALL NQN� Issued by: Date Re-roofs Signamm of ApPliceHAZAR O Da¢ HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future WIIJing acupmt arena or handle hvaNuus memriel ax ticftmd by the Cupertino Monte pit de.Chapter 9.12,and the Hcaath and Safety COde,Sectio 25532())] All roofs shall be inspected prior to any roofing material being installed. ❑Yes o Will the applicant Or fu( hu to dicapant use cyuinmcnl ordcviaa which If a roof is installed without first obtaining an inspection,I agree to remove h.,h d.us air c.nmminm¢as land by the Bay Arca Air Quality Management all new materials for Inspection. mt7 ❑Yet No I have mail the husmthws materials requirements under Chapterd.95 of the Califon his Hca INA,Safety Cotte,Sections 25505,25533 and 25534,1 untlersmad than if Ne Wilding Joe)not Conrad,hew:)meant,than it is my fesponsi hility I.and lynhe cocupam of 0c rcw met e. Signature of Applicant Date w a Ot ow r.ra.mornedagent ate All roof coverings to be Class "B"or better © CITY OF CUPERTINO �CE 03 u7oi Z CuPEI�TINO PERMIT APPLICATION FORM PN # ,� S� 7 ! Z Date: 7 Z V Building Address: Mailing Address (if different from building address): 21 6 -7 Sfi~cve Owner's N e: Phone#: ��6 Contra or .( � Q�� ' License#: Contact: Phone: Cupertino Business License#: Fax: g PPrmit Info: :B'I; lect Plmb M chscri it f��—J G Residential ❑ `�'G Sq.Ft. Floor Area: . $/Sq.Ft.: Cost of Project: ALIN / 1 f Occupancy Group: Type of Construction: U V Please check this box i is a second-story addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V<= I OOOA ELECTRICAL BELEC1001 Elec 600V> 1 OOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING Ask BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILJDING I of 3. � - CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL I 7!E BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTNIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backfio PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAMHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Appazatus ELECTRICAL 2 of 3 CITY OF CUPERTINO Cin OF PERMIT APPLICATION FORM CUPERTINO Qua0ty I Fee ID Fee Description Fee Grou BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3